Before heading off to Nashville last weekend, I twisted my finger, took some ibuprofen, and clutched an ice pack. Didn't help. I wandered around an enormous health care conference, amid literally thousands of hot shot doctors and health care innovators, feeling way too ridiculous about approaching any of them to ask if they could fix my poor little pinkie.

I got home midweek, put up with it for another day (it's quite hard to type accurately with nine fingers when the 10th one has doubled in size) and finally caved in. No I didn't go to the ER (not if I wanted to show my face at the office after all we've written about inappropriate use of emergency care). I called my "primary care provider." She's been my physician for more than a decade, and I like and trust her. But I know that she doesn't treat even minor orthopedic problems herself, she refers me to specialists. Sometimes she's even gotten on the phone herself to a specialist to get me in quickly (because all those people who yell and scream about waiting lists in England and Canada sure haven't tried to see a new doctor quickly here in the good old USA...).

I described my injury, and said, "Don't tell me I have to see an orthopedist."

She laughed. "You have to see an orthopedist." Not any orthopedist, a hand specialist. No, she said when I tried to bargain with her, she didn't think it was smart to just go to one of those nighttime care clinics (the one I take my kids when they get strep on a weekend) and get taped up. I'm a writer. I need my fingers.

Now I used to have a great hand specialist. A rare surgeon who respected what I knew about my own body, treated me conservatively, and never brandished a scalpel in my presence. But he is no longer in my health plan. And I couldn't see paying out of network for one-third of one little finger. I began dialing (pinkie-free) the list of doctors my physician had given me and lucked out. One had just had a cancellation. I could come in the next morning. Since we've written a lot in the last few months about perverse incentives and overuse of imaging, I joked with a physician friend by e-mail about whether I'd have to have an MRI to get a finger splint.

Since I liked the new doctor I saw—and I have to see him again in two weeks—I won't tell you how long I had to wait. (At least he apologized—and they considerately booked my follow-up appointment at a time he's unlikely to run late) He didn't require an MRI—but I did have three x-rays—even before he examined me. And frankly I'm not sure three, two, or even one of them were necessary. The x-rays did establish that the reason my finger has been hurting me so much for the past six days is (duh) I broke it. But did it really matter if I had a small break or a bad sprain? Would I have ended up in a splint either way? Would I be back in the office in two weeks to see if the swelling had subsided, I had regained my mobility, whether I needed a bit of PT? I'm not the clinician. I don't know.

I suspect I know what some readers are thinking. If we had malpractice reform, the doctor wouldn't have ordered all those tests. Maybe, maybe not. Maybe that's just the way he learned to practice medicine, his idea of being careful and thorough and conscientious. Maybe he has found his busy office works better if he routinely x-rays everyone with certain complaints, or that he is a better diagnostician if he looks at films before he looks at the patients. Maybe he has found that patients demand tests whether they need them or not, because that's what they see on TV, and it's easier just to do it than argue about it.

And some readers may be wondering whether if I had more "skin in the game" (no pun intended—besides this was a bone) instead of a $20 co-pay, I would have shopped around, or been more assertive. Had they prescribed an MRI instead of an x-ray, I probably would have objected more strenuously. But I've never understood how shopping around works. If four doctors gave me four different answers, how do I, as a layperson, really know what the right treatment is? And if the more conservative doctor who scanned less didn't have an opening for six weeks, might I be worse off delaying treatment than seeing the one with the busy x-ray room quickly? What are the chances of me actually getting doctors on the phone to ask such questions? Besides, if I (a working mother of two with a full-time job, a backlog of writing projects, a car in the shop, and a to-do list you don't even want to think about—why do you think I'm writing this at 5:00 a.m.?) had time to be calling all those doctors would I have let a whole week go by before taking care of a broken finger?

I could go on—because my simple medical problem really illustrates so much of what's wrong with health care and what we need to do to fix it.

• We need best practices or some kind of similar guidelines so doctors and patients both know what is and what isn't effective and expected.
• We need sensible payment reform so that physicians order tests because they enhance quality of care, not because the system rewards them if they just order more stuff whether we need it or not.
• We need a system that encourages greater continuity of care, rather than having doctors jump in and out of insurance plans, disrupting our doctor-patient relationships. And health IT so that my doctors and I can access old tests and images if for some reason I do have to change hand doctors yet again.
• We need efficient practices so you don't have to count on a lucky scheduling break to see a doctor when you need one.
• We need to make sure that all other working moms who do klutzy things have health insurance, like I have (even if the insurance is covering all three x-rays but wouldn't pay for my nifty blue and silver $2 splint).

We could also probably do with stronger fingers.